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Early prediction of survival following induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) using FDG PET/CT imaging in patients with locally advanced head and neck squamous cell carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Locally advanced head and neck squamous cell carcinoma (HNSCC) has a high rate of recurrence. Induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) before chemoradiotherapy could lead to the best disease control of inoperable stage III/IV HNSCC but with an increased risk of acute toxicity. Early assessment of therapeutic efficacy is a key issue in considering the benefit of escalation in a poor prognosis population.

Methods

Patients with stage III/IV HNSCC, in whom DCF induction chemotherapy followed by concurrent chemoradiotherapy had been validated by a multidisciplinary team, were prospectively included in the study. FDG PET/CT scans were performed in all patients before and after two of the three cycles of DCF. EORTC99 criteria were used to evaluate PET responses as follows: group 1 (metabolic responders) showing a complete response (CR) or partial response (PR), and subgroup 0 (metabolic nonresponders) showing stable disease (SD) or progressive disease (PD). The primary endpoint for monitoring patients was event-free survival (EFS). EFS probabilities between the two groups were estimated by the Kaplan-Meier method and statistically compared using the log-rank test.

Results

Fifteen consecutive patients (14 men, 1 woman; age 57.5 ± 6.2 years, mean ± SD) were analysed. Therapeutic assessment by PET/CT demonstrated CR in four patients, PR in six, SD in four and PD in one. Among the ten patients with a metabolic response (group 1), none had relapsed at the time of this report, while four of five patients with no metabolic response (group 0) showed recurrence within an average of 9.0 ± 1.6 months. Median EFS was, respectively, 18.9 months (3.8–25.3 months) and 10.2 months (7.5–12.7 months) in group 1 and group 0. The corresponding 1-year EFS rates were 100 % and 20 %, respectively. The difference in EFS between the two groups was statistically significant (p = 0.0014).

Conclusion

Early therapeutic response demonstrated on FDG PET/CT after two cycles of induction chemotherapy with DCF in patients with inoperable stage III/IV HNSCC seems to be a predictive factor for EFS.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Brest, Boulevard Tanguy Prigent, 29200, Brest, France

    Ronan Abgral, Pierre-Yves Le Roux, Nathalie Keromnes, Solène Querellou & Pierre-Yves Salaün

  2. Department of Radiology, Military Hospital of Brest, Brest, France

    Jean Rousset

  3. Department of Head and Neck Surgery, University Hospital of Brest, Brest, France

    Gérald Valette

  4. Department of Radiotherapy and Oncology, Regional Hospital of Quimper, Quimper, France

    Dominique Gouders, Cyril Leleu & Delphine Mollon

  5. Clinical Investigation Center INSERM 02-05, University Hospital of Brest, Brest, France

    Emmanuel Nowak

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  1. Ronan Abgral
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Abgral, R., Le Roux, PY., Keromnes, N. et al. Early prediction of survival following induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) using FDG PET/CT imaging in patients with locally advanced head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging 39, 1839–1847 (2012). https://doi.org/10.1007/s00259-012-2213-x

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